Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8273 | CT |
NPI | 1003990623 |
---|---|
Provider Name | Dr. Qin Bai |
First Address | Bloomfield, CT 06002 |
Second Address | Bloomfield, CT 06002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |